Hormone Treatment For Prostate Cancer Nz

What Are The Symptoms Of Prostate Cancer

Early prostate cancer causes no symptoms. As the cancer grows, it can cause urinary symptoms such as problems with flow or irritation of your bladder. These include:

• poor flow of urine
• pain when peeing
• blood in your pee.

Most of the time these symptoms are due to other common problems such as benign enlargement of the prostate gland or urinary tract infection . However, if you have any symptoms let your doctor know so they can assess your risk of getting prostate cancer and provide advice on whether or not to do prostate testing. In the late stage of prostate cancer, the cancer cells might spread to other parts of your body and cause symptoms such as:

• new bone or back pain
• both legs swelling

What Kinds Of Hormone Therapies Are Used To Lower Testosterone

The type of hormone therapy you may be offered depends on your type of prostate cancer, personal preferences and if youâve had any other treatments.

This type of hormone therapy lowers the amount of testosterone made by your testicles.

There are two commonly used types:

• LHRH agonistsLHRH stands for luteinising hormone-releasing hormone. These medications prevent your testicles from receiving the message from your brain to produce testosterone.

  Examples of LHRH agonists include leuprolide/leuprorelin and goserelin which is an implant.

• GnRH antagonists:GnRH stands for gonadotropin-releasing hormone. Similar to LHRH agonists, these medications also prevent the testicles from making testosterone.

  Degarelix is an example of a GnRH antagonist.

Both are commonly used to treat prostate cancer that has spread to other locations like bones and lymph nodes . They can also be used along with radiation therapy in less advanced prostate cancer.

Depending on the specific medication, it can be given:

• once every 3, 4 or 6 months

Speak to your doctor about the availability of these medicines and what your exact treatment plan might be.

Anti-androgens work by preventing testosterone from getting to and acting on the prostate cancer cells. Theyâre usually not used on their own to treat prostate cancer but combined with other hormone therapies or treatments.

Some anti-androgens also work by preventing cells from making testosterone. This includes the drug, abiraterone acetate .

Drug Triggers Immune Cells To Attack Prostate Cancer

by Julia Evangelou Strait, Washington University School of Medicine

A single drug compound simultaneously attacks hard-to-treat prostate cancer on several fronts, according to a new study in mice and human cells. It triggers immune cells to attack, helps the immune cells penetrate the tumor, and cuts off the tumor’s ability to burn testosterone as fuel, according to new research from Washington University School of Medicine in St. Louis. The drug may offer a promising new strategy for treating patients whose tumors don’t respond to standard therapy.

The study appears online in the journal Nature Communications.

Prostate cancer is notorious for eventually developing resistance to standard treatments that block or reduce testosterone, which fuels growth of these tumors. And like many solid tumors, prostate cancer also has proven stubbornly resistant to newer immunotherapies, which are intended to take the brakes off the immune system’s T cells to get them fighting cancerous invaders. Immunotherapiesmost commonly, immune checkpoint inhibitorscan be extremely effective but only in certain cancers, such as melanoma.

“We need to develop better therapies for prostate cancer patients, because most of these tumors develop resistance to hormone-based therapies doctors rely on to treat these cancers,” said senior author Nupam P. Mahajan, Ph.D., a professor of surgery.

More information:Nature CommunicationsJournal information:

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How Do You Know If Hormone Therapy Is Working To Treat Prostate Cancer

During treatment, youâll have regular PSA tests to see how well itâs working. You may also have your testosterone levels checked regularly, to make sure the hormone therapy is lowering your testosterone. If your PSA level goes down, it can mean your treatment is working as planned. The speed at which it falls and how much it falls will be different from one individual to another.

However, if your PSA levels keep rising, your doctor will talk to you about other treatment options. Consistently rising PSA levels can mean the hormone therapy is not working well.

Radiation Therapy: Effective For Prostate Cancer

Research published in the Journal of Medical Imaging and Radiation Oncology in 2015 shows that external-beam radiation therapy is a highly effective treatment option for prostate cancer.

Men with localised prostate cancer who are treated with external-beam radiation therapy have a cure rate of 95.5% for intermediate-risk prostate cancer and 91.3% for high-risk prostate cancer.

The 5-year survival rate using this treatment is 98.8% overall.

When compared to other common treatment options such as surgery or brachytherapy, external-beam was as effective and in some cases more effective.

A/Prof Tom Shakespeare, Radiation Oncologist at the North Coast Cancer Institute, led the eight year study comparing the effectiveness of external-beam radiation therapy with other common treatment options such as surgery or brachytherapy.

The main outcome that we have seen from this study is that external-beam radiation therapy is one of the most effective treatment options for prostate cancer, he said.

These are great results showing that radiation therapy is as effective, or even better, than other common treatment options such as surgery or brachytherapy.

In fact, based on the literature reviewed, it appears that external-beam radiation therapy is a superior treatment in some cases.

When patients are treated with modern external-beam radiation therapy, the overall cure rate was 93.3% with a metastasis-free survival rate at 5 years of 96.9%.

Unfortunately, this does not always happen.

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First Day Of Treatment

Please arrive 10-15 minutes before your allocated treatment time so we can greet you and allow you time to get changed for your treatment. Please bring an extra layer of clothing should you feel cold while you wait in the treatment reception area. Please report to the ARO reception desk. For free parking please refer to the information below. See location and parking for more information.

How Does Hormone Therapy Work Against Prostate Cancer

Early in their development, prostate cancers need androgens to grow. Hormone therapies, which are treatments that decrease androgen levels or block androgen action, can inhibit the growth of such prostate cancers, which are therefore called castration sensitive, androgen dependent, or androgen sensitive.

Most prostate cancers eventually stop responding to hormone therapy and become castration resistant. That is, they continue to grow even when androgen levels in the body are extremely low or undetectable. In the past, these tumors were also called hormone resistant, androgen independent, or hormone refractory however, these terms are rarely used now because the tumors are not truly independent of androgens for their growth. In fact, some newer hormone therapies have become available that can be used to treat tumors that have become castration resistant.

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How Is Hormone Therapy Used To Treat Hormone

Hormone therapy may be used in several ways to treat hormone-sensitive prostate cancer, including:

Early-stage prostate cancer with an intermediate or high risk of recurrence. Men with early-stage prostate cancer that has an intermediate or high risk of recurrence often receive hormone therapy before, during, and/or after radiation therapy, or after prostatectomy . Factors that are used to determine the risk of prostate cancer recurrence include the grade of the tumor , the extent to which the tumor has spread into surrounding tissue, and whether tumor cells are found in nearby lymph nodes during surgery.

The use of hormone therapy before prostatectomy has not been shown to be of benefit and is not a standard treatment. More intensive androgen blockade prior to prostatectomy is being studied in clinical trials.

Relapsed/recurrent prostate cancer. Hormone therapy used alone is the standard treatment for men who have a prostate cancer recurrence as documented by CT, MRI, or bone scan after treatment with radiation therapy or prostatectomy.

Hormone therapy is sometimes recommended for men who have a “biochemical” recurrencea rise in prostate-specific antigen level following primary local treatment with surgery or radiationespecially if the PSA level doubles in fewer than 3 months.

Last Week Of Treatment

An appointment will be scheduled for you to meet with a member of our patient care team to answer any questions and to ensure appropriate care is organised after your last treatment visit. This may include regular monitoring of blood results, appointments for dressings and management of side effects.

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Which Treatment To Choosewith Whom

Who Will Be On My Treatment Team

From the time that you are diagnosed with prostate cancer, you may be cared for by one or more of a team of health professionals, including:

• your family/whnau doctor who will often be the first person you see
• a urologist a doctor who specialises in the care of men with prostate cancer, providing medical and surgical care
• medical oncologists doctors who are responsible for prescribing targeted therapies, immunotherapy, chemotherapy and other aspects of cancer care
• radiation oncologists doctors who specialise in the use of radiation treatment
• radiation therapists people who plan and give you your radiationtreatment
• a cancer nurse coordinator and/or clinical nurse specialist a person who acts as a point of contact for you in different parts of the health service. They support and guide you and your family/whnau to keep you fully informed about your care
• outpatient nurses nurses who work alongside doctors during their clinics.

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Other Factors To Consider:

It is easier to monitor the control of the cancer after surgery, as the PSA should fall to undetectable levels.

In addition, the prostate once removed is examined by a pathologist, and the size of the tumour and margin status are reported , this all provides valuable information about outcome / prognosis.

The PSA should fall to undetectable levels after surgery. The PSA normally drops below 2ug/L with brachytherapy, but in about 20% of men it can fluctuate. This bounce effect can be disconcerting.

What Are The Risk Factors For Prostate Cancer

The risk of prostate cancer increases as you age and also if your brother or father has it.

• Age the risk of prostate cancer increases as you age. It is rare in men under 50. Men under the age of 70 who get prostate cancer are more likely to need treatment. This is because younger men live longer with their cancer so it has more time to progress and cause problems.
• Family history you have double the chance of getting prostate cancer if your father or brother has had prostate cancer. The risk is less if your grandfather or uncle has had prostate cancer.
• Genetics your risk of prostate cancer is higher if you have the BRCA gene.
• Abnormal prostate testing if you have done a PSA test and a digital rectal examination before and been told that the results are abnormal, your risk of getting prostate cancer is higher.

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What Are The Treatment Options For Prostate Cancer

If you have prostate cancer, you will be referred to a specialist and a radiation specialist. The choice of treatment depends on the size, type, growth and spread of the cancer, and your age, general health, symptoms and personal choice. Talk to your doctor to find out the best treatment options for you.

Treatment options for prostate cancer include active surveillance, surgery, radiation therapy , hormone therapy and palliative care.

Treatment To Lower Androgen Levels From Other Parts Of The Body

LHRH agonists and antagonists can stop the testicles from making androgens, but cells in other parts of the body, such as the adrenal glands, and prostate cancer cells themselves, can still make male hormones, which can fuel cancer growth. Some drugs can block the formation of androgens made by these cells.

Abiraterone blocks an enzyme called CYP17, which helps stop these cells from making androgens.

Abiraterone can be used in men with advanced prostate cancer that is either:

• Castration-resistant

This drug is taken as pills every day. It doesnt stop the testicles from making testosterone, so men who havent had an orchiectomy need to continue treatment with an LHRH agonist or antagonist. Because abiraterone also lowers the level of some other hormones in the body, prednisone needs to be taken during treatment as well to avoid certain side effects.

Ketoconazole , first used for treating fungal infections, also blocks production of androgens made in the adrenal glands, much like abiraterone. It’s most often used to treat men just diagnosed with advanced prostate cancer who have a lot of cancer in the body, as it offers a quick way to lower testosterone levels. It can also be tried if other forms of hormone therapy are no longer working.

Ketoconazole also can block the production of cortisol, an important steroid hormone in the body, so men treated with this drug often need to take a corticosteroid .

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When Is Hormone Therapy Used

Hormone therapy may be used:

• If the cancer has spread too far to be cured by surgery or radiation, or if you cant have these treatments for some other reason
• If the cancer remains or comes back after treatment with surgery or radiation therapy
• Along with radiation therapy as the initial treatment, if you are at higher risk of the cancer coming back after treatment
• Before radiation to try to shrink the cancer to make treatment more effective

Using Complementary Or Traditional Healing

Sometimes people with cancer might think about using complementary therapies or traditional healing.

Some alternative, complementary and traditional healing methods may react with the treatment you receive and cause harmful side-effects.

It is important to talk to your treatment team about any other therapies youre using or thinking about because they may interfere with hospital treatment.

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Heres What The Results Showed

After a median follow-up of just over 10 years, 9.7% of men who were treated with radiation and leuporelin for 18 months had died from prostate cancer, compared to 13.3% of the men treated with radiation and leuporelin for six months. Adding zoledronic acid made no difference in either case.

The authors concluded that hormonal therapy is more effective at preventing prostate cancer death when its given for 18 months rather than six. And similar benefits were noted for other endpoints as well. For instance, prostate tumors were less likely to metastasize, or spread, among men in the longer duration treatment group, and it took longer for their cancers to become resistant to hormone therapy if it was reinitiated later.

In earlier clinical research, scientists discovered that hormonal therapy given for three years protects against prostate cancer death more effectively than a six-month treatment regimen. But three years of hormone therapy isnt easily tolerated, and evidence so far shows that 10-year survival rates after either 18 months or three years of hormonal therapy are similar, the authors of the new study claim.

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Radiopharmaceuticals For Painful Bone Metastasis

When cancer spreads to bones, it can sometimes cause great discomfort and impact your quality of life. This therapy involves injecting a group of radioactive drugs such as radium into the body, to settle into bones with cancerous cells and kill them. It can often relieve pain for long periods of time.

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Treatment To Lower Testicular Androgen Levels

Androgen deprivation therapy, also called ADT, uses surgery or medicines to lower the levels of androgens made by the testicles.

Orchiectomy

Even though this is a type of surgery, its main effect is as a form of hormone therapy. In this operation, the surgeon removes the testicles, where most of the androgens are made. This causes most prostate cancers to stop growing or shrink for a time.

This is done as an outpatient procedure. It is probably the least expensive and simplest form of hormone therapy. But unlike some of the other treatments, it is permanent, and many men have trouble accepting the removal of their testicles. Because of this, they may choose treatment with drugs that lower hormone levels instead.

Some men having this surgery are concerned about how it will look afterward. If wanted, artificial testicles that look much like normal ones can be inserted into the scrotum.

LHRH agonists

Luteinizing hormone-releasing hormone agonists are drugs that lower the amount of testosterone made by the testicles. Treatment with these drugs is sometimes called medical castration because they lower androgen levels just as well as orchiectomy.

With these drugs, the testicles stay in place, but they will shrink over time, and they may even become too small to feel.

• Leuprolide mesylate

LHRH antagonists

Possible side effects

Many side effects of hormone therapy can be prevented or treated. For example:

Treatments For Metastatic Prostate Cancer

Hormonal therapyHormonal therapy is a common treatment choice in the advanced stages of prostate cancer, as it acts to block the effect of male hormones on the prostate. It cannot cure the cancer, but it can shrink the tumour or decrease the growth rate of the cancer. It is often used in conjunction with another treatment option. Find out more about hormonal therapy

External beam radiation therapyHigh-energy X-rays are focused at the area the cancer has affected to kill the cancer cells. It can be used in conjunction with brachytherapy in some cases. See more information about external beam radiation therapy

Treatments for Localised Prostate Cancer

SurgerySimple surgery can be used to ease symptoms, however radical surgery is used to treat prostate cancer by removing the entire prostate.

BrachytherapyBrachytherapy involves the insertion of a small radioactive source inside the prostate to kill the cancer cells.

CryotherapyCryotherapy for prostate cancer involves the controlled freezing of the prostate gland in order to destroy cancerous cells.

These treatments are available in the Bay of Plenty, at Grace Hospital in Tauranga in the following forms:

Robotic Assisted Laparoscopic ProstatectomyA robotic assisted laparoscopic radical prostatectomy is the removal of the entire prostate gland using advanced robot technology.

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